Provider Demographics
NPI:1043967284
Name:NICHOLSON, SHADESIA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHADESIA
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SHADESIA
Other - Middle Name:
Other - Last Name:CHRISTOPHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 639295 DEPT 93394
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9295
Mailing Address - Country:US
Mailing Address - Phone:248-434-6169
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:236 CLEARFIELD AVE STE 215
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1893
Practice Address - Country:US
Practice Address - Phone:248-434-6169
Practice Address - Fax:855-618-6655
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024183858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily